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Urinary diversion and reconstruction surgery

Urinary diversion is a way of surgically rerouting or diverting urine flow from its normal pathway in order to treat the condition of diseased or defective ureters, bladder or urethra, either temporarily or permanently. Using the surgical method of urinary reconstruction and diversion a new way is created for the patient to pass urine.

For all of these procedures, a portion of the small and/or large bowel is disconnected from the fecal stream and used for reconstruction.

Ileal Conduit Urinary Diversion: The ileal conduit urinary diversion surgery is used in patients who have had their bladder removed and is usually used in conjunction with radical cystectomy in order to control invasive bladder cancer. In this procedure, the ureters are surgically unattached from the bladder and a ureteroenteric anastomosis is made in order to drain the urine into a detached section of ileum (a part of the small intestine). The end of the ileum is then brought out through an opening (a stoma) in the abdominal wall. The urine is collected through a bag that attaches on the outside of the body over the stoma. The bag must be periodically emptied of urine.

Indiana Pouch Reservoir: The Indiana pouch surgery is used for patients who have had their urinary bladders removed as a result of bladder cancer, pelvic exenteration, bladder exstrophy or who are not continent due to a congenital, neurogenic bladder. In this procedure, a reservoir, or pouch, is created out of approximately two feet of the ascending colon and a portiom of the ileum (a part of the small intestine). The ureters are surgically removed from the bladder and repositioned to drain into the pouch. A piece of small intestine is brought out through a small opening in the abdominal wall called a stoma. Since a segment including the large and small intestines are utilized, also included is the ileal-ceceal valve. This is a one-way valve located between the small and large intestines which normally prevents the passage of bacteria and digested matter from re-entering the small intestine. After a period of several weeks, the body adjusts to the absence of this valve by absorbing more liquids and nutrients. Unlike other urinary diversion and reconstruction techniques, the Indiana pouch has the advantage of not using an external pouch adhered to the abdomen to store urine.

Neobladder to Urethra Diversion: With the Neobladder to Urethra Diversion procedure, the intent is to create a new bladder that mimics the storage function of a normal urinary bladder. The surgery makes a reservoir or pouch by utilizing a small part of the small intestine and connects the pouch to the urethra. The ureters are repositioned to drain into this pouch. As in normal urinary system, urine is able to pass from the kidney, to the ureters, to the pouch, and through the urethra out of the body.